Provider Demographics
NPI:1972834679
Name:VINCENT R BENIG MD LTD
Entity Type:Organization
Organization Name:VINCENT R BENIG MD LTD
Other - Org Name:SHOREWOOD FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-729-1010
Mailing Address - Street 1:1144 W JEFFERSON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-1700
Mailing Address - Country:US
Mailing Address - Phone:815-729-1010
Mailing Address - Fax:
Practice Address - Street 1:1144 W JEFFERSON ST STE 200
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-1700
Practice Address - Country:US
Practice Address - Phone:815-729-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty